Provider Demographics
NPI:1891960456
Name:YOUNG JUN AN ,D.D.S. INC.
Entity Type:Organization
Organization Name:YOUNG JUN AN ,D.D.S. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KHALDOUN
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-988-9959
Mailing Address - Street 1:5658 SEPULVEDA BLVD
Mailing Address - Street 2:204
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91411-2915
Mailing Address - Country:US
Mailing Address - Phone:818-988-9959
Mailing Address - Fax:818-988-9952
Practice Address - Street 1:5658 SEPULVEDA BLVD
Practice Address - Street 2:204
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91411-2915
Practice Address - Country:US
Practice Address - Phone:818-988-9959
Practice Address - Fax:818-988-9952
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-24
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty